behavioral health impact sitrep-week of july 20-final draft · behavioral health impact situation...

Publication 821‐102‐07

Week of July 20, 2020

Behavioral Health Impact Situation Report This situation report presents the potential behavioral health impacts of the COVID‐19 pandemic for Washington to inform planning efforts. The intended audience for this report includes response planners and organizations or individuals who are responding to or helping to mitigate the behavioral health impacts of the COVID‐19 pandemic.

Purpose This report summarizes data analyses conducted by the COVID‐19 Behavioral Health Group’s Impact & Capacity Assessment Task Force. These analyses assess the likely current and future impacts of the COVID‐19 pandemic on mental health and the potential for substance use issues among Washingtonians.

Key Takeaways Emergency visit counts for suicidal ideation and suicide attempts are statistically elevated,

notably among 15–24 year‐olds and individuals identifying as Hispanic or Latino.

Weekly survey data suggest that anxiety and depression are increasing among Washington adults. On at least most days, nearly 1.9 million adults are experiencing symptoms of anxiety and over 1.2 million adults are experiencing symptoms of depression.

Surveillance data suggest that adolescents and young adults are experiencing disproportionately high behavioral health symptoms, relative to their older counterparts.

Domestic violence reports appear to be decreasing but remain higher than 2019 levels.

Impact Assessment This section summarizes data analyses that show the likely current and future impacts of the COVID‐19 pandemic on mental health and potential for substance use issues among Washingtonians.

Syndromic Surveillance Syndromic surveillance data are collected in near real‐time from hospitals and clinics across Washington. Key data elements reported include patient demographic information, chief complaint, and coded diagnoses. This system is the only source of emergency department (ED) data for Washington. Statistical warnings (yellow dots) and alerts (red dots) are displayed when a Centers for Disease Control and Prevention (CDC) algorithm detects a weekly count at least

Behavioral Health Impact Situation Report: Week of July 20, 2020 2

three standard deviations1 above a 28‐week average count, ending three weeks prior to the week with a warning (p < 0.05) or alert (p < 0.01).

Relative to 2019, there was a 40–50% decline in volume of visits across care settings that corresponds to the “Stay Home, Stay Healthy” order implemented on March 23 (CDC Week 13 in graphs below).2 For this reason, indicators are presented as a count of ED visits, rather than a percentage of ED visits for 2019 and 2020. Data for past weeks are subject to updates.

Psychological Distress A previously‐reported warning for ED visits for psychological distress3 in CDC Week 26 (week of June 21) was updated to an alert. Following an alert in CDC Week 27 (week of June 28), the 15–24 year‐old age group saw a warning for ED visits for psychological distress in CDC Week 29 (week of July 12). Yakima County saw its fourth consecutive alert for ED visits for psychological distress, and Columbia County saw an alert in CDC Week 29.

Graph 1: Count of emergency department visits for psychological distress3 in Washington, by week: 2020 vs. 2019 (Source: CDC ESSENCE)

1 Standard deviation: A measure of the amount of variation or dispersion of a set of values. Standard deviation is often used to measure the distance of a given value from the mean, or average, value of a data set. 2 Hartnett K. P., Kite‐Powell A., DeVies J., et al. Impact of the COVID‐19 Pandemic on Emergency Department Visits — United States, January 1, 2019–May 30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:699–704. DOI: http://dx.doi.org/10.15585/mmwr.mm6923e1 3 Psychological distress in this context is considered a disaster‐related syndrome comprised of panic, stress, and anxiety. It is indexed in the Electronic Surveillance System for the Early Notification of Community‐based Epidemics (ESSENCE) platform as Disaster‐related Mental Health v1. Full details are available at https://knowledgerepository.syndromicsurveillance.org/disaster‐related‐mental‐health‐v1‐syndrome‐definition‐committee.


Suicidal Ideation and Suicide Attempts While counts of recent ED visits for suicidal ideation remain comparable to 2019 levels (Graph 2), there was a warning for ED visits for suicidal ideation in CDC Week 28 (week of July 5). This warning coincided with alerts for 15–24 year‐olds, men, and individuals identifying as Hispanic or Latino. As with psychological distress, Yakima County saw its fourth consecutive alert for ED visits for suicidal ideation in CDC Week 29. Additionally, Lewis and Ferry counties saw statistically elevated levels of ED visits for suicidal ideation in both CDC Week 28 and Week 29. Island County also saw an alert in CDC Week 29.

Graph 2: Count of emergency department visits for suicidal ideation in Washington, by week: 2020 vs. 2019 (Source: CDC ESSENCE)


The previously‐reported warning for ED visits for suicide attempts in CDC Week 28 was updated to an alert (Graph 3). As with suicidal ideation, there were coinciding alerts for 15–24 year‐olds and individuals identifying as Hispanic or Latino. There was also an alert for women, along with a warning for men. Additionally, Jefferson and Yakima counties saw statistically elevated levels of ED visits for suicidal ideation in both CDC Week 28 and Week 29, while Island and Stevens counties saw alerts in CDC Week 29.

Graph 3: Count of emergency department visits for suicide attempts in Washington, by week: 2020 vs. 2019 (Source: CDC ESSENCE)


Substance Use — Drug Overdose and Alcohol-Related Emergency Visits A second consecutive alert for ED visits related to overdose of any drug4 was triggered for CDC Week 28. Both alerts are associated with men, individuals identifying as American Indian or Alaska Native, and individuals identifying as Native Hawaiian or Other Pacific Islander. The Week 28 alert is also associated with 15–24 year‐olds, individuals identifying as White, and individuals identifying as non‐Hispanic or Latino. Spokane and Walla Walla counties both saw a warning in CDC Week 28, Stevens County saw an alert in CDC Week 29, and Yakima County saw a warning in CDC Week 29 (following three consecutive alerts).

Graph 4: Count of emergency department visits for overdose by any drug4 in Washington, by week: 2020 vs. 2019 (Source: CDC ESSENCE)

4 This definition specifies overdoses for any drug, including heroin, opioid, and stimulants. It is indexed in the Electronic Surveillance System for the Early Notification of Community‐Based Epidemics (ESSENCE) platform as CDC All Drug v1. Full details available at https://knowledgerepository.syndromicsurveillance.org/cdc‐all‐drug‐v1.


The count of alcohol‐related ED visits reported for CDC Week 29 is not statistically elevated, but the alerts for CDC Weeks 26–28 are all associated with men, 35–44 year‐olds, individuals identifying as White, and individuals identifying as non‐Hispanic or Latino. Additionally, populations associated with two out of the three recent alerts include 15–24 year‐olds and residents of Cowlitz and Okanogan counties. Finally, alcohol‐related ED visits in Yakima County triggered an alert for a fourth consecutive week.

Graph 5: Count of alcohol‐related emergency department visits in Washington,

by week: 2020 vs. 2019 (Source: CDC ESSENCE)


General Surveillance — Symptoms of Anxiety and Depression Survey data collected by the U.S. Census Bureau5 between July 9–14 suggest that nearly 1.9 million Washington adults are experiencing symptoms of anxiety on at least most days and over 1.2 million are experiencing symptoms of depression on at least most days.

Graph 6: Estimated Washington adults with feelings of anxiety and depression at least most days, by week: April 23–July 14 (Source: U.S. Census Bureau)

Further analysis of the anxiety measure for July 2–7 survey data indicate an inverse relationship between age and frequency of anxiety symptoms. In other words, as age increases, frequency of anxiety symptoms decreases. Nearly half (47%) of 18–29 year‐olds report feeling nervous, anxious, or on edge at least most days, compared to less than one‐third of 60+ year‐olds. A similar inverse relationship can be seen between household income and frequency of anxiety symptoms. Individuals in a household that experienced a loss of employment income report feeling anxious on at least most days approximately twice as often as those who have not experienced such a loss (48% and 24%, respectively). Individuals identifying as non‐Hispanic and either multi‐racial or White are significantly more likely to report frequent symptoms of anxiety than other ethnic/racial categories (42% or 37% vs. <30%). Finally, women are significantly more likely than men to report having feelings of anxiety on at least most days (42% and 28%, respectively).

Further analysis of the depression measure will be included in a future report.

5 In May, the U.S. Census Bureau began measuring the social and economic impacts during the COVID‐19 pandemic with a weekly Household Pulse survey of adults across the country. Four questions ask survey respondents how often they have experienced specific symptoms associated with anxiety and depression over the past week.

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Crime — Domestic Violence The week of July 6–12 saw the lowest year‐over‐year difference in reported domestic violence offenses (+4%) since the Washington Association of Sheriffs and Police Chiefs (WASPC) began surveying law enforcement agencies (LEAs) in early April. Paired with a relatively low (+7%) increase during the previous week, reported domestic violence offenses appear to be decreasing but remain elevated above 2019 levels. Meanwhile, other surveyed offenses – including theft, destruction of property, assault, and burglary – have been consistently lower than the corresponding weeks in 2019 (over 25% lower).

Graph 7: Domestic violence offenses reported, by week for April 6–July 12: 2020 vs. 2019 (Source: WASPC)

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Telephonic Support Line Activity — Suicidality and Substance Use There is no update since the Week of July 13 Situation Report for data related to the Washington State Tobacco Quitline (WAQL), Washington Recovery Help Line (WRHL), and Suicide Prevention Lifeline (SPLL). While calls to the WAQL were down 41% year‐over‐year in April and May combined, June WAQL call volume was comparable to that for 2019. Meanwhile, WRHL calls have steadily increased since April, averaging 10% monthly growth through June. Considered together, the data suggest that Washingtonians struggling with substance use are increasingly seeking support. In May, the SPLL received 21% more calls than in April.

There is no update since the Week of June 22 Situation Report for data related to the Washington Poison Center. According to the Washington Poison Center, suspected suicide cases among 13–17 year‐olds are up 4% from 2019 to 2020 for the period of January 1–June 10, which is greater than the 2% increase across all ages.

Product Sales — Alcohol and Marijuana Taxes & Handgun Background Checks There is no update since the Week of July 13 Situation Report for data related to product sales.

The Liquor and Cannabis Board (LCB) summarizes monthly beer, wine, and marijuana tax collections, which may be used as a representation for sales of legal recreational substances and, by extension, potential for substance use issues. Additionally, federal background checks for handgun sales6 may represent access to firearms,7 which is a risk factor for suicide and other gun violence.8

Monthly marijuana tax collections in the first half of 2020 were consistently higher than in 2019, while changes in year‐over‐year monthly beer and wine tax collections (combined) have fluctuated, but are generally increasing. Additionally, federal background checks for handgun sales in Washington were 45% (roughly 39,000) higher for the period of March–June 2020 compared to the corresponding period in 2019. However, the state’s increase is less than half of the overall United States increase (+109%).

6 From the Federal Bureau of Investigation: “It is important to note that the statistics within this chart represent the number of firearm background checks initiated through the NICS [National Instant Criminal Background Check System]. They do not represent the number of firearms sold. Based on varying state laws and purchase scenarios, a one‐to‐one correlation cannot be made between a firearm background check and a firearm sale.” 7 Nemerov, Howard Ross, Estimating Guns Sold by State (January 11, 2018). Available at SSRN: http://dx.doi.org/10.2139/ssrn.3100289 8 Anglemyer, A., Horvath, T., Rutherford, G. The accessibility of firearms and risk for suicide and homicide victimization among household members: a systematic review and meta‐analysis [published correction appears in Ann Intern Med. 2014 May 6;160(9):658‐9]. Ann Intern Med. 2014;160(2):101‐110. doi:10.7326/M13‐1301


Social Media — Expressions of Positive Sentiment, Loneliness, and Anxiety Social media data show more positive signs. Tweets related to COVID‐19 and geo‐tagged to Washington9,10 suggest that positive sentiment is increasing and anxiety is decreasing, both toward pre‐pandemic levels. Loneliness decreased slightly since July 12 and remains slightly below pre‐pandemic levels.

Graph 8: 7‐day moving averages of deviations in select expression measures9,10 relative to January 2020 baseline: March 7, 2020–July 19, 2020 (Source: Penn Center for Digital Health)

To request this document in another format, call 1‐800‐525‐0127. Deaf or hard of hearing customers, please call 711 (Washington Relay) or email [email protected].

9 Since January 2020, researchers at the Penn Center for Digital Health have been tracking “tweets” about the COVID‐19 pandemic, analyzing language used by Twitter users to quantify the extent to which they reflect expressions of positive sentiment, loneliness, and anxiety. Although these measures have been made publicly available, the researchers included a disclaimer, stating that “the data are still being validated and are not ready for public policy decision making.” 10 Guntuku, S.C., Sherman, G., Stokes, D.C., et al. Tracking Mental Health and Symptom Mentions on Twitter During COVID‐19. J GEN INTERN MED (2020). https://doi.org/10.1007/s11606‐020‐05988‐8

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